ASHP Survey Shows Growing Role of Pharmacists in Transitions of Care Services

Pharmacists in hospitals across the U.S. are performing more medication-related patient transition of care interventions, 24/7 medication order review, and patient medication counseling.


Pharmacists in hospitals across the U.S. are performing more medication-related patient transition of care (TOC) interventions, 24/7 medication order review, and patient medication counseling, according to the ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration—2014.

The use of smart pumps, barcode-assisted medication administration, computerized prescriber order entry (CPOE) systems, and electronic health record (EHR) systems also continues to grow in hospitals of all sizes. Pharmacists’ movement into more direct patient care roles combined with the widespread use of medication-use technology are improving efficiency, safety, and clinical outcomes, according to authors Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA; Philip J. Schneider, M.S., FASHP, FFIP, FASPEN; and Douglas J. Scheckelhoff, M.S., FASHP.

The survey of 1,435 pharmacy directors who work at general and children’s medical-surgical hospitals in the U.S. found that a number of hospital and health-system medication-use practices have improved dramatically since 2005. For example, 24/7 pharmacist medication order review and consultation is now available in 80 percent of hospitals (up from 30 percent in 2005). In addition, pharmacists in hospitals surveyed increasingly provide TOC services, including the following:

  • Medication reconciliation services (60.9 percent)
  • The development of patient-specific medication action plans (11.1 percent)
  • Pharmacist counseling in (41.9 percent)
  • Pharmacist participation in discharge planning (31.6 percent)

“The significant growth in pharmacists’ medication-management services and the rise in the use of medication-use technology are positive trends contributing to increased patient safety and improved patient outcomes,” said Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, AJHP Editor in Chief. “Pharmacists’ leadership has been critical to implementation of these services and safety measures in healthcare settings across the U.S.”

ASHP’s national survey, which is organized into six components of the medication-use system (prescribing, transcribing, dispensing, administration, monitoring, and patient education), provides an overall picture of the contemporary roles that pharmacists play in managing medication use.

The survey found a number of improvements in the use of medication-safety technology, including the following:

Smart Infusion Pumps

Overall, 80.5 percent of hospitals now use smart infusion pumps — up from 32.2 percent in 2005. Although the use varies by size of hospital, 100 percent of hospitals with more than 600 beds use smart pumps, up from 83.9 percent in 2009. In smaller hospitals (50 beds or fewer), 67.1 percent use smart infusion pumps (up from 40.5 percent in 2009).

Barcode-Assisted Medication Administration (BCMA)

BCMA is now used in 88.4 percent of hospitals to verify patient identity and electronically check doses administered by nurses. By contrast, only 34 to 65.8 percent of hospitals used BCMA in 2011. Mid-size hospitals (200-299 beds) had the highest use of BCMA, while small hospitals (100-199 beds) had the lowest use of BCMA.

Electronic Health Record (EHR) Systems

Overall, 94.1 percent of hospitals have partially or completely implemented an EHR. The use of EHR systems has increased since 2009 among hospitals of all sizes, with growth ranging from 6.9 to 42.4 percent.

Computerized Prescriber-Order-Entry (CPOE) Systems

CPOE systems are found in 80.9 percent of hospitals. In hospitals of all sizes, growth in CPOE systems since 2009 has ranged from 35.4 percent to 76.2 percent.

The survey report appears in the July 1 issue of AJHP. For log-in information and access, please contact Jocelyn Milford.